ࡱ> ?A>O bjbj .օeօeO @L L 8Z&  (555%%%%%%%$N(+%%55&^55%%r$TY%50@nF%%*&0Z&'%2++Y%+Y%l%%<Z&+L W: Sample Assent Form Social and Behavioral Sciences Form Parts in Italics should be modified for your specific project. Other parts may need to be modified as well, depending on your research methods. Make sure your language is appropriate for your age group! Elements to include in an assent form: brief statement of purpose; description of procedures (including duration); indication of the voluntary nature of agreeing to participate; description of pain or discomfort that may be experienced; brief explanation of alternatives (if relevant); description of benefit or compensation, if any; and offer to answer questions. Other suggestions for Assent Forms Keep pronoun usage consistent throughout the document. Attach charts or pictures that might be helpful to the child. The use of larger type might also be helpful to young children. Studies involving older children or adolescents should include more information and may use more complex language than studies involving younger children Sample Minor Assent Document Project Title: Investigator: We are doing a research study about (purpose in simple language). A research study is a way to learn more about people. If you decide you want to be part of this study, you will be asked to (description, including time involved). There are some things about this study you should know. There are (procedures, things that take a long time, other risks, discomforts, etc.) Not everyone who takes part in this study will benefit. A benefit means that something good happens to you. We think these benefits might be (description). If you do not want to be in this research study, we will tell you what other kinds of treatments there are for you. (Note: This statement applies only to research projects that offer treatment or intervention). When we are finished with this study we will write a report about what was learned. This report will not include your name or that you were in the study. You do not have to be in this study if you do not want to be. If you decide to stop after we begin, thats okay too. No one will be mad at you if you decide not to do this study. You may ask questions about the study at any time. Do you have any questions? If you decide you want to be in this study, please sign your name. I agree _______I do not agree ________to participate in this study which I have read or which has been explained to me by ____________________ ___________________________________ _______________ (Sign your name here) (Date) ___________________________________ _______________ (Signature of Person Obtaining Assent) (Date)     Revised 2/1/07 Page  PAGE 1 of  NUMPAGES 2 6789 . / |    R S m n   Z [ 56ABypgypgypgypgyp^ph.h6aJhsh6aJh656aJhsh656aJh&B*phhsh65B*\phhsh6B*ph h66aJ *h~pLh~pL6aJ h~pL6aJhsh66aJ h6aJhsh65jhsh65U\]hsh65\]hsh656\]$89  / L } + ` |  V  $a$gd6 & Fdd[$\$gd6 dd[$\$gd6 & Fdd[$\$gd6gd6$a$gd6   - .   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